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Full text of "Military health care system : comparing obstetrics costs between a military treatment facility and CHAMPUS"

•DTTDT&- M- 



NAVAL POSTGRADUATE SCHOOL 

Monterey, California 




THESIS 



MILITARY HEALTH CARE SYSTEM: COMPARING 

OBSTETRICS COSTS BETWEEN A MILITARY TREATMENT 

FACILITY AND CHAMPUS 

by 

Julito Pedrozo Laluan 

September, 1991 



Thesis Advisor: 



Dr. Dan Trietsch 



Approved for public release; distribution is unlimited 



T257830 



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6c ADDRESS (City, State, and ZIP Code) 
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1 1 TITLE (Include Security Classification) 

MILITARY HEALTH CARE SYSTEM: COMPARING OBSTETRICS COSTS BETWEEN A MILITARY TREATMENT FACILITY AND 
CHAMPUS (Unclassified) 



12 PERSONAL AUTHOR(S) Laluan, Julito P. 



13a TYPE OF REPORT 
Master's Thesis 



13b TIME COVERED 
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14 DATE OF REPORT (year, month, day) 
September, 1991 



15 PAGE COUNT 
76 



16 SUPPLEMENTARY NOTATION 

The views expressed in this thesis are those of the author and do not reflect the official policy or position of the Department of Defense or the U.S. 

Government. 



17 COSATI CODES 



FIELD 



GROUP 



SUBGROUP 



18 SUBJECT TERMS (continue on reverse if necessary and identify by block number) 

Obstetrics Recapture, Cost Analysis: Obstetrics, 
Obstetrics Costs Comparison: MTF and CHAMPUS. 



19 ABSTRACT (continue on reverse if necessary and identify by block number) 

For more than three decades, two systems or programs have provided health care for military beneficiaries: ( 1 ) the direct care system, 
whereby beneficiaries obtain health care services from military treatment facilities (MTFs), and (2) CHAMPUS (Civilian Health and 
Medical Program of the Uniformed Services), a health program in which beneficiaries receive care from civilian facilities. The high 
cost to DoD of supplying inexpensive medical care, as well as concern over timeliness of service, has prompted many suggestions for 
reforming the military health care system. Based on the above, the objective of this research is to compare costs between a military 
treatment facility and CHAMPUS and to determine whether a given MTF 1 can provide inpatient care to its beneficiaries at lower cost 
than through CHAMPUS. By comparing MTF and CHAMPUS costs, a given MTF can identify those specialty areas in which to 
reduce costs either by increasing workload (use of recapture and/or normal increase of appointments) or increasing referrals to 
outside health care providers. 



20 DISTRIBUTION/AVAILABILITY OF ABSTRACT 

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22a NAME OF RESPONSIBLE INDIVIDUAL 
Dr. Dan Trietsch 



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Approved for public release; distribution is unlimited. 

Military Health Care System: Comparing Obstetrics Costs Between A Military 
Treatment Facility And CHAMPUS 



by 



Julito P 7 Laluan 

Lieutenant, United States Navy 

B.S., University of the State of New York, Albany, 1978 

M.A., National University, San Diego, 1987 

Submitted in partial fulfillment 
of the requirements for the degree of 

MASTER OF SCIENCE IN MANAGEMENT 

from the 

NAVAL POSTGRADUATE SCHOOL 
September 1991 / 



ABSTRACT 

For more than three decades, two systems or programs have provided health care 
for military beneficiaries: (1) the direct care system, whereby beneficiaries obtain health 
care services from military treatment facilities (MTFs), and (2) CHAMPUS (Civilian Health 
and Medical Program of the Uniformed Services), a health program in which beneficiaries 
receive care from civilian facilities. The high cost to DoD of supplying inexpensive medical 
care, as well as concern over timeliness of service, has prompted many suggestions for 
reforming the military health care system. Based on the above, the objective of this 
research is to compare costs between a military treatment facility and CHAMPUS and to 
determine whether a given MTF can provide inpatient care to its beneficiaries at lower cost 
than through CHAMPUS. By comparing MTF and CHAMPUS costs, a given MTF can 
identify those specialty areas in which to reduce costs either by increasing workload (use 
of recapture and /or normal increase of appointments) or increasing referrals to outside 
health care providers. 



in 



77 

6.1 



TABLE OF CONTENTS 

I. INTRODUCTION 1 

A. BACKGROUND 1 

B. OBJECTIVES OF THE RESEARCH 2 

C. RESEARCH QUESTION 3 

D. SCOPE 4 

E. METHODOLOGY 5 

II. THE MILITARY HEALTH CARE 6 

A. OVERVIEW 6 

B. THE MILITARY HEALTH CARE SYSTEM AND ITS 
PROBLEMS 6 

C. UNDERSTANDING MILITARY HEALTH CARE 7 

D. ACTIVE DUTY DEPENDENTS 8 

E. RETIREES' AND THEIR DEPENDENTS 9 

F. OTHER HEALTH CARE SERVICES 10 

III. THE CHAMPUS PROGRAM 12 

A. BACKGROUND 12 

B. THE CHAMPUS PROGRAM AND ITS PROBLEMS 12 

C. HOW CHAMPUS PROGRAM WORKS 13 

D. THE CHAMPUS REFORM INITIATIVE 15 



xv 






IV. METHODOLOGY 17 

A. SOURCES OF DATA 17 

B. OVERVIEW OF MEPRS 17 

C. CALCULATING COSTS USING PATIENT TREATMENT 
PROTOCOLS 2 

D. MEPRS DATA 2 

E. CHAMPUS COST DATA 22 

F. METHODOLOGY APPLICATION 22 

V. DISCUSSION AND ANALYSIS 25 

A. CHAPTER OVERVIEW 25 

B. ANALYSIS 26 

VI. CONCLUSIONS AND RECOMMENDATIONS 32 

A. CONCLUSIONS 32 

B. RECOMMENDATIONS 34 

APPENDIX A (PERFORMANCE DESCRIPTIONS) 36 

APPENDIX B (OCCUPIED BED DAY DATA) 37 

APPENDIX C (DIRECT EXPENSE REPORT) 38 

APPENDIX D (STEPDOWN SCHEDULE) 39 

APPENDIX E (FINAL PURIFICATION REPORT) 42 

v 



APPENDIX F (COMPUTATION SUMMARY) 43 



APPENDIX G (INPATIENT NAS REPORT) 44 



APPENDIX H (HEALTH CARE SUMMARY) 61 



APPENDIX I (SUMMARY OF COSTS /WORKLOAD) 65 



APPENDIX J (INPATIENT SPECIALTY) 66 



APPENDIX K (GLOSSARY) 67 



LIST OF REFERENCES 68 



INITIAL DISTRIBUTION LIST 69 



VI 



I . INTRODUCTION 

A . BACKGROUND 

Champus is the Civilian Health and Medical Program of the 
Uniformed Services, a Department of Defense program for 
reimbursing individuals and health care providers for services 
provided for eligible beneficiaries and retirees. It picks up 
most of the costs for treatment in civilian medical facilities 
when military hospitals and clinics are too distant or busy. 
Basically, the dependents of active-duty members, retirees and 
their dependents under 65, some former spouses of service 
members, and certain survivors can use CHAMPUS. So may the 
families of reserve and National Guard members called to 
active duty. After paying an annual deductible, beneficiaries 
of active duty members are responsible for 20% of allowable 
charges for outpatient care and a small daily fee or $25.00 
whichever is higher for inpatient care. Additionally, 
beneficiaries of retirees pay 25% for outpatient and inpatient 
care (after paying an annual deductible) . However, some 
people are not eligible for CHAMPUS, such as active-duty 
military, parents, parents-in-law, and most persons eligible 
for Medicare hospitalization insurance . [Ref. l:pp. 11-14] 

For the past decade, the CHAMPUS budget has gruwn 
substantially as a result of several factors. First, the 



Department of Defense has expanded in size significantly, 
resulting in a greater number of military personnel whose 
medical care is the responsibility of the military. Second, 
there is a rise in total national health care expenditures 
[Ref. 2:p. 1-3,5]. These costs have grown excessively when 
compared to the acceptable level of inflation, as both 
personnel costs and technology related with health care 
services have increased. Also, there is a substantial number 
of service personnel entering the military with dependents 
compared to previous years. These additional dependents, 
especially children, have a tremendous need for medical 
services. Consequently, this need for health care far exceeds 
the capacity of overburdened military facilities. 

B. OBJECTIVES OF THE RESEARCH 

For more than three decades, two systems have provided 
health care for U.S. military beneficiaries: (1) the direct 
care system, whereby beneficiaries obtain health care services 
from military treatment facilities (MTF's), and (2) CHAMPUS 
(Civilian Health and Medical Program of the Uniformed 
Services) , a health program in which eligible beneficiaries 
receive care from civilian facilities . [Ref . 9:p. v) 

The Department of Defense (DoD) now spends approximately 

$5 billion a year on medical services. About $4 billion of 

this spending covers most of the military treatment facilit ies 

(MTF) . The cost to DoD of supplying inexpensive medical ce.re, 



as well as concern over timeliness of service, has prompted 
many suggestions for reforming the military health care 
system. 

For the past 10 years, CHAMPUS costs have increased 
significantly. Inspite of the higher costs, CHAMPUS is not 
adequate nor fully acceptable because of its coverage 
limitations, high out-of-pocket costs compared to other forms 
of insurance, and program complexity . [Ref. 3:p. 1] 

Based on the above, the objective of this research is to 
compare MTF and CHAMPUS costs and to determine whether a given 
MTF can provide inpatient care to its beneficiaries at lower 
cost than through CHAMPUS. The analysis provides a method of 
calculating MTF specialty cost per admission that can be 
compared to the equivalent specialty cost reported by CHAMPUS . 

C. RESEARCH QUESTION 

The primary question of the thesis is: Can we use 
inpatient treatment protocols as a basis or methodology for 
comparing costs between CHAMPUS and an MTF. 

A subsidiary question is: 

1. Will it be cost-effective to treat beneficiaries in 
military treatment facilities? 



D . SCOPE 

This thesis will concentrate on two localized areas: (1) 
Fort Ord Army Hospital (an MTF) in California, and (2) a 
localized area called catchment 1 , in the vicinity of the 
military treatment facility. In order for the beneficiaries 
to use CHAMPUS, they must first obtain an NAS (non- 
availability statement) that the MTF cannot provide the 
required care. 

The analysis and comparison of costs will be limited to a 
particular inpatient specialty or procedure, Obstetrics, which 
FT Ord can provide. 

Within the financial records for the catchment area and 
Fort Ord Army Hospital, the procedure for analysis will focus 
on Obstetrics costs which were paid for by using CHAMPUS funds 
in 1990. This is the most recent year for which complete set 
and relevant data exists. Consequently, and for consistency, 
the costs to be used for the Ft Ord-MTF (Obstetrics) will be 
for 1990. 



1 This catchment area include all beneficiaries residing 
near Fort Ord (within 40 mile radius) who use CHAMPUS as thsir 
primary insurer for inpatient care. 



E . METHODOLOGY 

Normally, participating health care providers bill 
CHAMPUS, and other government agencies according to a set of 
standards and codes for each procedure performed. 

The research uses data on cost per admission from the 
CHAMPUS Inpatient Availability Statement (NAS) report. The 
analysis concentrates on the CHAMPUS cost for NAS (Obstetrics) 
cases because these cases are the best candidates for 
recapture. The Inpatient NAS report provides the combined 
cost of hospital and professional services for NAS cases in 27 
hospital specialties. 

The MTF cost per admission for obstetrics patients is 
developed using data from the Medical Expense and Performance 
Reporting System (MEPRS) . MEPRS tracks total costs 
(hospitalization and physician costs) and occupied bed days 
(OBDs) by functional work centers. MEPRS data on cost per OBD 
by work center can be used to calculate cost per admission 
given information on treatment protocols that identify the 
number of days the typical patient remains in each MEPRS work 
center. The cost of each protocol is calculated by summing 
the product of number of days spent in each work center and 
corresponding cost per OBD. 



II. THE MILITARY HEALTH CARE 

A . OVERVIEW 

Both Chapters II and III will further explore the DoD and 
CHAMPUS programs. These chapters will also note some 
differences between the two. 

B. THE MILITARY HEALTH CARE SYSTEM AND ITS PROBLEMS 

For many years, military beneficiaries have enjoyed 
unlimited medical benefits. However, for the past decade 
these benefits have shrunk for many beneficiaries as the 
military struggles to bring health care costs under control. 
Economic and political realities are making it harder to 
fulfill promises of adequate benefits for service members, 
retirees, and their dependents [Ref. 4:p. 10]. In addition, 
deductibles have tripled for CHAMPUS beneficiaries, except for 
dependents of service members below grade E-5, and dental 
premiums have gone up as well. 

These cutbacks come on top of longstanding complaints of 
dependents and retirees about military medicine: crowded 
emergency rooms, long waits for appointments and limited 
access to dental care. Furthermore, staff shortages have 
prevented some military facilities from using all their 
services; some operating suites and intensive care units have 
been closed. The war in the Persian Gulf exacerbated the 



situation, adding reservists' (who were called for active 
duty) families to those seeking services, while pulling staff 
away from military hospitals. 

The military medical system is confusing for most 
beneficiaries. Different categories of people, active duty, 
retirees, and the dependents of each, eligible for different 
benefits. What they are eligible for is not necessarily what 
is available at their local installation. 

To cope with skyrocketing medical costs, the military is 
moving towards enrolling CHAMPUS-eligible beneficiaries in 
networks of doctors who agree to rates set by the government. 
The consequence is that patients would lose the freedom to 
choose their own health care provider but would pay less and 
find more medical staff accessible . [Ref. 5:pp. 12-13] 

C. UNDERSTANDING MILITARY HEALTH CARE 

To understand military medicine, it is important to note 
that active-duty individuals are treated first before others. 
Preservation of the fighting force is military medicine' s 
fundamental mandate. Treatment of others comes only if 
medical staff and resources are available after caring for 
those in uniform. 

Second on the list are dependents of active-duty members, 
including dependents of reservists on active duty. Retirees 
and their dependents comes last. 



As with any hospital, however, the military's priority 
list is put aside during emergencies. No one in need of 
emergency medical care is turned away. 

Members on active duty receive free medical care, 
including hospitalization, medicines, immunization shots, 
regular physical exams and routine dental care. Also, all 
military hospitals can treat any member of the seven . .iformed 
services: the Army, Marine Corps, Navy, Air Force, Coast 
Guard, Public Health Service, and National Oceanic and 
Atmospheric Administration. And active-duty members who 
cannot get to a military facility for emergency medical care 
may be treated at civilian hospitals; the government will pay 
the bill. 

Access to the Department of Defense' s medical resources is 
controlled by DEERS (Defense Eligibility and Enrollment 
Reporting System) . This is the military' s computerized roster 
of people eligible for military benefits; active-duty 
personnel are automatically listed and family members 
qualifying as dependents must also be enrolled. 

D. ACTIVE DUTY DEPENDENTS 

Dependents of active-duty members and activated reserves 
are eligible for treatment at military treatment facilities as 
long as they are enrolled in DEERS. 



Those qualifying as dependents include: 



1. The spouse and unmarried children (under 21 years of 
age) of active-duty members; 

2. Unmarried children over 21 who receive more than 50 
percent of their financial support from a military 
parent (limited to children with physical or mental 
handicap) ; 

3. Unmarried children not yet 23 years old who are full 
time students at accredited colleges and who must 
depend on a military parent; 

4. Parents or parents-in-law who live in a residence 
provided or maintained by their active-duty son or 
daughter (in-law) and who receive more than half their 
financial support from the service member; and 

5. Unremarried widows and widowers of active duty members 
or retirees . [Ref. l:p. 15-20] 



Dependents can receive different kinds of medical services 
at military treatment facilities and this includes but is not 
limited to: treatment of medical and surgical conditions, 
physical examinations, prescriptions and non-prescription 
drugs, maternity and infant care, diagnostic tests and 
services, emergency dental care, and ambulance service when 
medically necessary. 

E. RETIREES' AND THEIR DEPENDENTS 

As with active-duty dependents, retirees and their 
families do not face any charges for outpatient treatment at 
military treatment facilities. 

Enlisted members are not charged for inpatient care while 
retired officers and warrant officers pay a nominal fee of 



$4.90 a day for meals (for 1991) . Spouses and dependents of 
retirees' are billed $8.55 a day (for 1991). 

Retirees are also eligible for medical care from the 
Department of Veterans Affairs (VA) . Priority is determined 
as follows: 



First priority (Category A) includes all veterans with 
service connected disabilities; veterans claiming 
exposure to Agent Orange while serving in Vietnam; and 
those veterans claiming exposure to ionizing radiation 
through occupation in Hiroshima or Nagasaki, Japan 
following detonation of the nuclear device or through 
testing of those or other such devices. Veterans such 
as former prisoners of war are automatically included 
in Category A. Also included are veterans with an 
annual income of $17,240 or less if they have no 
dependents, or $20,688 with one dependent, plus $1,150 
for each additional dependent. This group is 
considered mandatory; and 

Discretionary care that is provided if space and 
resources are available, covers veterans with 
disabilities that are not service-connected and whose 
annual income is between $17, 241-$22, 986 if they have 
no dependents, or between $20, 689-$$28733 with one 
dependent, plus $1,150 for each additional dependent. 
Veterans in this category must pay a deductible equal to 
what is paid under Medicare, $628 in 1991. They are 
also charged $10 a day for inpatient care, $5 a day for 
nursing home care, and $2 6 for each outpatient 
visit. [Ref . 6:pp. 17-18] 



F. OTHER HEALTH CARE SERVICES 

In an effort to reduce and alleviate overcrowding at 
military treatment facilities, the services have opened a 
number of medical clinics. These clinics are manned by 
civilian health care practitioners and under contract to 
provide primary care to both active-duty and retired military 



10 



members and their dependents. The Navy calls its clinics 
NavCare; the Army and Air Force call them PRIMUS. Eligible 
members and their dependents may avail themselves of any of 
these clinics, which offer services free of charge. Services 
available at these clinics includes treatment for minor 
illnesses, routine physical exams, diagnostic services, X- 
rays, prescriptions and laboratory work. 

Members on active duty are also entitled to a complete 
dental care in military dental clinics. Active-duty 
dependents, including dependents of recalled reservists, 
retirees and their dependents, in that order of priority, may 
receive dental care at these facilities on a space-available 
basis. Such care is free, except that all dependents must pay 
for prosthetic devices. These charges reflect the cost of the 
materials and not the personnel costs. 

The Department of Defense also offers active-duty 
dependents in the U.S. and its territories dental treatment by 
civilian dentists through an insurance plan. The plan 
provides diagnostic care, oral exams, and preventive care such 
as fluoride treatments, through participating dentists at no 
additional charge. The plan pays 80 percent of the other 
charges and the patient pays 20 percent . [Ref. 7:pp. 1-5] 



11 



III. THE CHAMPUS PROGRAM 

A . BACKGROUND 

Health care for military beneficiaries is provided through 
a dual system: The Navy, Air Force, and Army operate 137 
hospitals and numerous clinics in the U.S. and overseas. When 
military treatment facilities cannot provide care for all 
eligible beneficiaries, their health care needs may be 
augmented by CHAMPUS, a health insurance plan that reimburses 
for health care services provided by civilian doctors to 
military dependents and beneficiaries below the age of 65. 
[Ref. 9:p. 1] 

CHAMPUS was created by Congress to supplement the 
military' s hospitals and clinics and to provide health care to 
retirees and their dependents who live far away from a 
military treatment facility. 

However, CHAMPUS does not cover all medical procedures. 
Even in cases of treatments it does cover, CHAMPUS does not 
automatically reimburse patients for all costs. 

B. THE CHAMPUS PROGRAM AND ITS PROBLEMS 

CHAMPUS has not been without criticism. Complaints have 
surfaced regarding how much military families must pay and 
delays in reimbursement. 



12 



Increased usage, coupled with sharply rising medical 
costs, has led CHAMPUS running over budget in recent years. 
This problem is not unique to the CHAMPUS program and has been 
experienced by most health insurance programs covering 
payments to hospitals, doctors, and other health care 
providers . [Ref. 2:pp. 1-8,9] 

The CHAMPUS program was designed originally to augment the 
military hospitals. However, it has become more of an 
enhancement to the military health care system provided to 
service members and its eligible beneficiaries. This is 
evidenced by the increase in its budget and the number of 
claims filed. In 1989, its total DoD budget was $2,742.1 
million, up from $2,506.3 million in 1988 [Ref. 2:p. III-3] . 
In 1989, the number of total claims was 11,657,348, up from 
10,678,201 in 1988 [Ref. 2:p. VI-35] . 

C. HOW CHAMPUS PROGRAM WORKS 

As with all health care programs, care is generally 
divided into outpatient and inpatient. Inpatient treatment 
occurs when an individual is admitted to a hospital with the 
reasonable expectation that such individual will stay at least 
24 hours. Outpatient occurs in a physician's office or 
clinic, or during a house call. 

With CHAMPUS, families are free to choose outpatient care 
from civilian providers with few restrictions. In the case of 
inpatient care, beneficiaries must have prior approval to use 



13 



a civilian hospital, or CHAMPUS will not cover the cost. 
However, under emergency condition this prior approval can be 
waived. Active-duty beneficiaries and retirees living within 
the catchment area of a military treatment facility must check 
there first to see if it can provide the treatment. Again, in 
emergencies, no one is turned away from a military hospital or 
clinic. 

The catchment area was once the region within a 40-mile 
radius around a military treatment facility. These areas now 
are defined by ZIP codes. If the military hospital cannot 
provide inpatient care, patients may be referred to a civilian 
hospital. Patients are given written authorization to use 
civilian facility and the authorization is called a non- 
availability statement (DD Form 1251) . 

Basically, the following groups are eligible for CHAMPUS 
benefits: Dependents of active duty members; surviving spouses 
and unmarried children of service members who died while on 
active duty; spouses and unmarried children of reservists who 
are ordered to active duty for more than 30 days, and the 
survivors of reservists who died on active duty; member of the 
reserves between the ages of 60 and 65 who are qualified to 
receive retired pay; surviving spouses and children of 
deceased retirees (spouses who remarry are ineligible unless 
married to eligible member) ; and children of active-CiUty 
member or retiree up to age 21 if not married, and to 23 years 
old if not married and in school full time. 

14 



As a rule, CHAMPUS coverage automatically ends when a 
participant turns 65. Most military retirees and their 
dependents lose CHAMPUS eligibility when they become eligible 
for Social Security's Medicare program. However, retirees and 
their dependents keep their privilege for treatment in 
military hospitals. 

D. THE CHAMPUS REFORM INITIATIVE 

In February 1988, the DoD awarded a contract to Foundation 
Health Corporation (FHC) to implement the CHAMPUS Reform 
Initiative (CRI) . Costs of running the military health care 
system in recent years have been escalating rapidly and 
exceeded $2.7 billion in fiscal year 1989. To contain these 
costs and to respond to criticism regarding access to military 
health care, and improve coordination between military and 
civilian health care providers, the DoD has developed the 
CHAMPUS Reform Initiative. 

Basically, the most important features of the CRI are the 
following: 



1. Selection of several contractors, each responsible for 
the financing and delivery of CHAMPUS services in an 
entire area; 

2 . A price fixed prospectively for all covered services 
delivered to CHAMPUS beneficiaries in the area; 

3. An alternative to current CHAMPUS, CHAMPUS Prime, that 
would offer improved coverage of primary care, reduced 
cost sharing, and simpler procedures to those 



15 



beneficiaries who enroll in the plan and use a panel 
of preferred civilian providers selected by the 
contractor; 

4. A Health Care Finder to help beneficiaries obtain 
appointments in the military facilities, referrals to 
appropriate civilian providers, and medical record 
transfers; and 

5. Resource sharing agreements between each civilian 
contractor and military hospital in his/her area in 
which the contractor agrees to provide manpower and 
other resources needed to increase capacity utilization 
within these hospitals . [Ref. 3:pp. 1-2] 



The CRI is undergoing trials in two states, California and 
Hawaii. And if its successful, the system will be phased in 
to other regions of the country in the future. 



16 



IV . METHODOLOGY 

A. SOURCES OF DATA 

The data used for this research come from two sources. 
The Fort Ord Army Hospital in Fort Ord, California furnished 
the MEPRS cost and related data on Obstetrics care for the 
fiscal year 1990. 

The second source was through the Office of Civilian 
Health and Medical Program of the Uniformed Services 
(OCHAMPUS) in Aurora, Colorado. OCHAMPUS provided the Health 
Care Summary Report and Inpatient NAS Reports. The Health 
Care Summary Report shows CHAMPUS utilization and cost data 
for the Fort Ord catchment area and the Inpatient NAS Report 
which was primarily used in this research shows the catchment 
area utilization and cost data by whether an NAS was required 
with the 27 hospital specialties. 

B. OVERVIEW OF MEPRS 

The Medical Expense and Performance Reporting System 
(MEPRS) contains cost and workload performance information for 
military treatment facilities. 

The MEPRS recognizes six general functional areas within 
an MTF : inpatient, outpatient, dental, ancillary services, 
support services, and special programs. Support services are 
laundry service, food service, housekeeping, and other non 



17 



medical functions. Ancillary services include clinical 
laboratory, pathology, radiology, pharmacy, and other related 
activities that contribute in the proper diagnosis and 
treatment of admitted patients. Special programs consist of 
graduate medical education, public health services, and 
decedent affairs. Within the general functional areas, MEPRS 
further identifies separate work centers of the MTF in which 
different services are performed. Therefore, it tracks 
workload and expenses by these work centers. 

Expenses from ancillary and support work centers are 
reallocated or reassigned to inpatient and other work centers 
and other final operating accounts. This allocation is the 
percentage of the ancillary and support workload performed for 
the work centers. For example, the performance factor for 
Blood Bank is weighted procedure (see Appendix A for sample of 
performance factors) . If 20% are served for Obstetrics, then 
20% of the cost of operating the Blood Bank are allocated to 
Obstetrics care (work center) . 

Expense information are entered in the MEPRS in the form 
of Direct Expense Schedule (DES) and it identifies all 
expenses directly associated with a given work center. 

Workload statistics are recorded into MEPRS in the form of 
stepdown assignment statistics (SAS) data sets. Each SAS data 
set is composed of a numerical identifier that is related vith 
a specific workload measure and a list of MEPRS work center 
and corresponding workload for that work center. Also, other 

18 



workload information are gathered from numerous sources, 
including the Automated Quality of Care Evaluation Support 
System (AQCESS) , which provides reports on OBD' s by work 
center; Tri-service Medical Information System (TRIMIS) , which 
provides reports on ancillary workload. 

The EAS is the automated system that processes the actual 
cost allocations from intermediate operating accounts to final 
accounts. The beginning of the process is the DES that 
identifies the direct expense of each work center, including 
ancillary and support work centers. During the stepdown 
process, the direct expenses of ancillary and support work 
centers are charged to the inpatient, outpatient, dental, or 
special programs work centers benefiting from the expenses. 

During the final or post-stepdown, expenses from cost 
pools are allocated to final operating accounts. Cost pools 
are established when costs are shared by two or more by final 
operating accounts. 

The Final Purification Report identifies the expense 
distribution from cost pools to final accounts. This report 
shows the dollar amounts calculated and allocated during 
purification. 

The Computation Summary reveals the breakdown of total 
work centers expense by direct expense, support costs, 
ancillary costs, expense from cost pools, and a final purified 
amount . 



19 



C. CALCULATING COSTS USING PATIENT TREATMENT PROTOCOLS 

To estimate MTF cost per patient admission, MTF physicians 
must identify major types of hospital admission and develop 
patient treatment protocol 2 for each. 

May [Ref 8] developed a method to estimate the costs. The 
cost of treating each patient admitted can be determined from 
the treatment protocols and the cost per OBD for each work 
center. The cost is estimated as weighted sum of the cost per 
OBD in each work center where the weights equal the number of 
days spent in each work center: 

Cost per admission = wi*Ci+ . . . wn*Cn i=l to n, 
where 

wi = number of OBD spent in work center i 
Ci = cost per OBD in work center i 
n = number of work centers. 

D. MEPRS DATA 

Data provided by Fort Ord Army Hospital covered only the 
inpatient services 3 and work centers that affected the 
computation of Obstetrics cost. Of the data provided, five 
reports were used for analysis that are directly related to 



2 For this research, a treatment protocol is defined as 
the number of days the typical patient with a certain 
diagnosis remains in each MEPRS work center. 

3 To date, there are 18 identified inpatient specialties 
within the Fort Ord Army Hospital (see Appendix J-Inpatient 
Specialties) . 

20 



the Obstetrics cases. Referring to Appendix B (Occupied Bed 

Day Data) , this report accounts all the occupied bed days for 

the inpatient work centers. Appendix C (Direct Expense 

Report) , this report shows the total salary of clinicians 

working in those particular work centers. Appendix D 

(Stepdown Schedule) enumerates all the ancillary and support 

costs allocated to the affected work centers. Appendix E 

(Final Purification Report) shows the allocated costs to 

different work centers from the ward cost pools. Appendix F 

(Computation Summary Report) integrates all the different 

costs allocated to the work centers. 

The MEPRS data provided by Fort Ord Army Hospital are up 
to September 30, 1990 and considered complete. However, the 
data provided need to be analyzed carefully because of the 
system's (MEPRS) inherent limitations. For example, data are 
collected by functional work center instead of by individual 
patient. When admitted patients in a given specialty are 
treated in two or more work centers, cost per admission must 
be calculated from data on cost per OBD by work center and 
treatment protocol developed for the specialty. Second, since 
MEPRS is an allocative system, a work center' s share of 
support and ancillary costs is determined from its relative 
share of weighted workload. If weights do not capture all 
differences in resource consumption for ancillary and support 
costs, then the allocated cost could be different from the 



21 



true cost. As a result of these limitations, the cost per 
admission in a given specialty using patient treatment 
protocols cannot be truly estimated from the true cost. 

E. CHAMPUS COST DATA 

The data provided by OCHAMPUS particularly the Inpatient 
Non Availability Statement report is considered complete for 
the fiscal year 1991. This report provides costs and 
utilization data for twenty-seven medical specialties. The 
report comprises the following types of admissions: emergency 
(no NAS required) ; and non-emergency (NAS required or not 
required) . This feature is very important because in NAS 
cases, CHAMPUS is the primary insurer and a given MTF 
generally absorbs all the costs of the admission. Thus, NAS 
cases are the best candidates for recapture. Furthermore, 
this report excludes the following types of data: CHAMPVA; 
contractor-denied claims; claims with zero government cost; 
hospital outpatient care; ambulatory surgery for active duty 
dependents; and all foreign country data (except Mexico and 
Canada) . 

F. METHODOLOGY APPLICATION 

Applying May's [Ref. 8] methodology on the MEPRS data, we 
can have a best estimate of the admission cost on different 
inpatient specialty or services (see Footnote 3) for the Fort 
Ord Army Hospital. For Obstetrics cases, the total expenses 



22 



in fiscal year 1990 is $2,449,541.00 which include the 
clinician salaries. The occupied bed days (OBD's) totaled to 
4,844 for 1,628 patients admitted (this data was derived from 
SAS Admissions Report). Dividing 4,844 OBD's by 1,628 
patients will result to average length of stay (ALOS) or 
occupied bed days of about three days (the exact number is 
2.975 days) . Furthermore, dividing the total expenses of 
$2,449,541.00 by the occupied bed days of 4,844 will yield a 
dollar amount of $505.69. This is the average cost per OBD in 
Obstetrics work center. To determine the total cost per 
admission for Obstetrics using the methodology: 

Cost for each admission = wi*Ci+ . . . . wn*Cn i=l to n, 
wi= 3 4 Ci= $505.69 n= 1 (see Footnotes 2 and 4). 

Therefore, the computed cost for each admission for 
Obstetrics at Fort Ord Army Hospital when using patient 
treatment protocol is $1,504.63. This is the amount used for 
comparing the cost between MEPRS and CHAMPUS . 

For CHAMPUS Obstetrics cases 5 for the year 1990 (see 
Appendix G, Total All Categories of Beneficiaries section, NAS 



'For the fiscal year 1990, 99.50% of patients admitted at 
Fort Ord Army Hospital for Obstetrics care were seen and 
treated at that work center. The remaining .50%, who were 
treated by two or more work center, were not included in the 
analysis because the effect is considered negligible in the 
final cost per admission. 

5 Obstetrics costs used in the computation are ccsts 
pertaining to mothers care only. Costs incurred for routine 
care for newborns are excluded. Similarly, Obstetrics costs 
incurred by the Fort Ord Army Hospital and used in the 
computation excludes newborn costs. 



23 



required), the total government cost is $314,365 for a total 
of 98 inpatient admissions. Dividing the total government 
costs by 98 total admissions will yield $3,207.80 average 
government cost per admission. The total hospital days or 
total occupied bed days is 272, divide this by total 
admissions will yield an average length of stay or average OBD 
of 2.77. Furthermore, dividing $3,207.80 by the average OBD 
or length of stay will yield $1,155.75 average government cost 
per occupied bed day. 



24 



V. DISCUSSION AND ANALYSIS 

A. CHAPTER OVERVIEW 

When to recapture? In order to answer this very important 
question when considering shifting (recapturing) CHAMPUS 
workload to a particular treatment facility, one has to 
explore the following issues that may affect the overall 
results of patients recapture. The primary goal of comparing 
CHAMPUS and MTF costs is to ascertain whether a given MTF can 
provide inpatient care at a lower cost than through CHAMPUS. 
However, the potential savings related to recapturing CHAMPUS 
workload vary significantly between patient to patient. 

First, the potential savings that could be derived from 
shifting CHAMPUS workload is dependent upon recaptured 
admissions because CHAMPUS coverage varies by status of 
patients and private insurance coverage. For eligible 
dependents who have private insurance, CHAMPUS is considered 
a secondary insurer. Therefore, it only pays charges not 
covered by the dependent's insurance . [Re f. 9: pp. 4-8] 

Second, many eligible dependents are considered 
transparent to the military health care system due to their 
infrequent use or non-use of military facilities or CHAMPUS 
for some or most of their health care needs. Therefore, 
drawing this population will increase the workload of the 



25 



military treatment facilities. And, since this population are 
viewed as ghosts by the military system, the potential gain in 
number may not reduce the CHAMPUS workload in equal number. 
In other words, cost advantage in favor of the MTF that exists 
per admission would be eventually offset by disproportionate 
increases in MTF workload. [Ref. 10:p. 1] 

Another issue to consider when recapturing is the 
potential effect on some aspects of medical care, as well as 
the overall satisfaction on the part of the recaptured 
population. By increasing the number of patients seen within 
a particular specialty, the access to that health care service 
would probably be affected not only in terms of longer lines 
(waiting to make an appointment or follow-up) but also the 
quality of time spent by the physician with his or her 
patient. Also, when recaptured, patients who are used to 
shopping for health services outside the MTF may no longer 
have any option available to them to see a particular 
specialist or doctor they prefer (exceptions are emergency 
conditions) and in some cases this will cause patient 
dissatisfaction. 

B. ANALYSIS 

Based on the data derived from MEPRS and OCHAMPUS, a 
summary of the computation is created to show the final costs 
and workload for the Obstetrics care incurred by the Fort Ord 
Army Hospital and CHAMPUS for FY 1990. 



26 



Referring to Appendix I, the average cost per admission at 
the MTF level is about $1,504.00. This number represents the 
average cost for inpatient care provided for one Obstetrics 
specialty patient. Again, this sum was derived by 
multiplying the average cost per occupied bed day, $505.69, by 
the average length of stay, which is 2.975 days. 

The CHAMPUS cost on Obstetrics care per admission within 
the Fort Ord catchment area is about $3,207.00 and this number 
is derived from the CHAMPUS NAS Inpatient Report. 

Based on the above there is a significant cost difference 
between the two programs. The net difference of $1,703 for 
each patient admission could represent a substantial savings 
if these Obstetrics patients (NAS required) were recaptured 
and treated within the military treatment facility. 

It should be noted, however, that the remaining 17 medical 
specialties within the Fort Ord Hospital were not compared and 
analyzed. Thus, the potential savings from these specialties 
and what their impact could be on the overall CHAMPUS for the 
catchment area cannot be truly ascertained. Despite this, it 
is widely accepted that military treatment facilities of any 
size can deliver health care service at lower cost. If this 
is so, the potential savings in recapturing patients under 
different types of medical specialties can be substantial not 
only to the overall CHAMPUS budget for the Fort Ord catchment 
area but also to the rest of catchment areas within the 
CHAMPUS program. 

27 



Based on the data analyzed in this research, shifting 
CHAMPUS Obstetrics (NAS required) cases back to the Fort Ord 
Army Hospital could have significantly reduced the overall 
CHAMPUS cost for the Fort Ord catchment for FY 1990. This 
potential savings represents a reduction in expenditures of 
almost 7 6 percent of the grand total of CHAMPUS and patients 
costs in all Obstetrics categories in the Fort Ord area. These 
categories are emergency medical treatment (no NAS required) , 
inpatient care where no NAS is required, and inpatient care 
where NAS is. required. Similarly, when the OBD cost on 
Obstetrics was compared to the CHAMPUS cost for FY 1990, the 
difference was almost a 50% in favor of MTF . 

It should be noted, however, that there are extra costs 
associated with any form of medical specialty recapture. And 
these costs are considered significant. Example of these 
costs are salaries of new doctors, additional ancillary costs, 
and other support costs. In the case of Fort Ord Army 
Hospital, a practical way to measure and to forecast future 
costs when recapturing Obstetrics patients are the use of 
established cost per occupied bed days. These costs are 
considered a good measure when comparing future costs since 
the OBD cost is composed of average cost incurred by the 
military hospital for doctors salaries, ancillary services, 
and other support costs for that work center. 

Furthermore, in analyzing the results of the data 
contained in this research, there are various reasons for 

28 



increases in number of CHAMPUS Obstetrics patients being 
referred to the civilian facilities, as well as increases in 
costs both for the CHAMPUS and patients within the Fort Ord 
catchment area. 

Currently, there are constraints in the supply of military 
physicians within Fort Ord Army Hospital not only in 
Obstetrics specialty but also in most clinical areas of the 
hospital. This situation is not unique to Fort Ord and is 
being experienced by other military treatment facilities as 
well. Since this is not unique to Fort Ord it is expected 
that some services have to be cut back and some have to be 
closed due to lack of necessary resources. Also, in addition 
to its requirement to provide health care to eligible 
beneficiaries, the military hospital is also mandated by 
higher authorities to support any national contingencies. For 
example, during the Persian Gulf crisis, a large number of 
medical personnel stationed at the hospital were sent to the 
area to support deployed personnel. And in anticipation of 
future casualties the hospital reduced and/or cut back some of 
its services available to eligible beneficiaries in the 
catchment area. This action by the hospital, preserving and 
conserving, some of its resources for contingencies, have 
resorted to more outside referrals of patients not only 
Obstetrics care but of other specialties as well. In FY 1990, 
the majority of patients (Obstetrics with NAS authorization) 



29 



who were referred to outside providers were dependents of 
active duty personnel. Therefore, the bulk of the total cost 
was absorbed by the government . 

It should be noted that in cases where a patient is seen 
by a nonparticipating provider, the cost in excess of allowed 
CHAMPUS amount must be paid by the patient. This plus the 
cost associated with yearly deductible payments will tend to 
increase the overall cost paid by the patient. So in reality, 
CHAMPUS covers less than 100 percent of the reported costs for 
active-duty dependents and covers less than 75 percent of the 
costs for retiree families. But since most of the civilian 
providers participate in CHAMPUS, thus agreeing to absorb 
costs in excess of the allowed CHAMPUS charges, the total 
costs reported and analyzed in this research approximates the 
allowable charges. 

Another reason in increased cost is the medical status of 
the patient itself. Patients are automatically referred to 
civilian providers when specialized care is needed because of 
some complications in their pregnancy and Fort Ord Army 
Hospital cannot provide the appropriate care. However, the 
correct number of these patients (with complications) cannot 
be obtain since their inpatient records were not screened for 
this purpose. At any rate, any kind of specialized care, if 
it were needed and obtained, will undoubtedly increase the 
cost of Obstetrics care. Thus, the potential savings 
calculated maybe overstated. 

30 



There is also the question of patient's proximity to the 
Fort Ord Army Hospital. There are cases where beneficiaries 
live in the outermost perimeter of the catchment area thereby 
access to the care needed is prohibitive. In these cases 
where geographic considerations have to be considered, the 
prudent choice by the military hospital is to refer them to 
the nearest civilian provider. 



31 



VI. CONCLUSIONS AND RECOMMENDATIONS 

A. CONCLUSIONS 

The methodology described in this research provides a best 
estimate in comparing Obstetrics costs between a military 
treatment facility and CHAMPUS . The CHAMPUS cost per patient 
admission can be derived from the CHAMPUS Inpatient NAS 
Report. The military treatment facility's cost can be 
constructed using patient treatment protocols, which describe 
the hospital stay by work center for different categories of 
patients, and cost per occupied bed day estimates from MEPRS . 

An important requirement when using this methodology, 
however, is the determination of relevant clinical specialties 
and the proper use of treatment protocols. Another 
requirement is the accuracy of workload data and costs data 
used in MEPRS. 

By comparing MTF and CHAMPUS costs, a given military 
treatment facility can identify those specialty areas in which 
to reduce costs either by increasing the MTF's workload (use 
of recapture and/or normal increase of appointments) or 
increasing referrals to outside providers. Similarly, 
additional recapture of different types of medical specialties 
must also be based on the requirements of the MTF, 



32 



availability of resources and consideration on the needs of a 
given specialty population. 

Based on the computations performed in Chapter IV and the 
analysis conducted in Chapter V, it can be concluded that 
recapturing and treating eligible beneficiaries at Fort Ord 
Army Hospital has a cost saving potential. In FY 1990, in the 
case of Obstetrics specialty, the MTF could have saved 
approximately $1,703.00 per admission if these patients were 
recaptured. 

However, when considering recapture, the overall mission 
capability of a given MTF must be seriously taken in to 
account. For example in FY 1990, in the case of the Fort Ord 
Army Hospital, the hospital has experienced shortages in 
military doctors especially in the Obstetrics and Gynecology 
specialty. This situation can be attributed to the 
longstanding manning constraint within the DoD health care 
system and which to some extent exacerbated by the war in the 
Persian Gulf when large number of the hospital's medical 
personnel have to leave to support deployed military 
personnel. Consequently, for that year, the military hospital 
resorted to more referrals of Obstetrics patients to outside 
health care providers . 

Another aspect in a recapture that is very important are 
the high costs related to any patients needing specialized 
health care. If the additional costs to be incurred in 



33 



specialized services are more than the savings to be realized, 
then it would probably be cost-effective to leave these 
patients unrecaptured. 

Also, use of OBD' s as a gauge on forecasting savings in 
costs must be done with caution since derivation of historical 
costs may not truly reflect the future costs. 

Finally, in light of the constraints placed on Fort Ord 
Army Hospital, as well as to other military treatment 
facilities within DoD, it would be prudent now to address any 
aspects of cost containment since the overall cost of 
providing military health care is rapidly escalating. 

B . RECOMMENDATIONS 

This research has analyzed and compared the costs of one 
medical specialty, Obstetrics, between a military treatment 
facility and its catchment area. Based on the data analyzed, 
it is evident that a significant savings could be realized 
when patients are recaptured back to the MTF . However, before 
attempting to shift major CHAMPUS workloads, by recapturing 
other specialties, a further study should be conducted in 
order to ascertain the full impact of the possible change, and 
to make sure that these changes are warranted. It should be 
noted that potential savings related with shifting CHAMPUS 
workload back to the MTF can vary because of dependents' 
status, private insurance coverage, and other costs associated 



34 



with any recapture (i.e., additional salaries for new doctors, 
expected increase in ancillary and support costs, etc.) . 
Therefore, it is recommended that: 



Cost analysis of the remaining 17 medical specialties, 
in the case of Fort Ord Army Hospital, be conducted and 
compared to the other CHAMPUS specialties within the Fort 
Ord catchment area. Such a study should cover a four to 
five year span in order to determine if there is a 
growing trend. 

A study should also be conducted, in conjunction with 
the above recommendation, on number and status of 
beneficiaries carrying any private insurance within the 
catchment area. If there is a significant number of 
beneficiaries having private insurance coverage, then it 
would probably be cost-effective to leave this 
population unrecaptured. 



35 



APPENDIX A 



EXAMPLE OF PERFORMANCE DESCRIPTIONS 

FORT ORD ARMY HOSPITAL, FY 1990 



ACCT DESCR IPTIONS PE RFORMANCE DESCRIPTION 

WEIGHTED PROCEDURE 
WEIGTED PROCEDURE 
WEIGHTED PROCEDURE 
WEIGHTED PROCEDURE 
PROCEDURE 

WEIGHTED PROCEDURE 
HOURS OF SERVICE 

MINUTES OF SERVICE 
MINUTES OF SERVICE 
VISIT 
MINUTES OF SERVICE 



DAA 


PHARMACY 


DBA 


CLINICAL PATHOLOGY 


DBC 


BLOOD BANK 


DCA 


RADIOLOGY 


DDA 


ELECTROCARD I OGRAPHY 


DDD 


PULMONARY FUNCTION 


DEA 


CENTRAL STERILE 




SUPPLY 


DFA 


ANESTHESIOLOGY 


DFB 


SURGICAL SUITE 


DHD 


PHYSICAL THERAPY 


DGA 


SAME DAY SURGERY 



36 



APPENDIX B 



STATISTICAL DATA SET (OCCUPIED BED DAY DATA) 

FORT ORD ARMY HOSPITAL, FY 1990 



UCA CODE 


QTR 1 


QTR 2 


QTR 3 


QTR 4 


AAAA 


1452 


1203 


1170 


1332 


AAFA 





4 


8 


4 


AAHA 


210 


253 


220 


245 


AAJA 


6 


13 


7 


39 


ABAA 


805 


868 


1022 


920 


ABCA 


46 


59 


42 


21 


ABEA 


46 


41 


46 





ABFA 


130 


191 


160 


142 


ABGA 


160 


147 


201 


151 


ABKA 


227 


301 


156 


4 


ACAA 


245 


356 


355 


315 


ACBA 


1306 


1011 


1168 


1359 


ADAA 


490 


429 


404 


422 


ADBA 


893 


782 


866 


839 


AEAA 


604 


871 


1008 


934 


AEBA 


79 


132 


109 


152 


AFAA 


921 


1047 


863 


888 


AGAA 


243 


309 


329 


302 


AGBA 


3 


10 


1 


1 


AGCA 


585 


732 


821 


683 


AGDA 


152 


79 


82 


78 


AGEA 


20 


49 


61 


16 


AGFA 











26 


AGGA 


3 


4 





23 


AGHA 


231 


196 


280 


291 



37 



APPENDIX C (DIRECT EXPENSE REPORT) 



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38 



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42 



APPENDIX F (COMPUTATION SUMMARY) 



PRFPAREO: 90 NCV 21 
F Atllll Y NAME: MEtDAt 
FAU Lll Y CODE: R2C4AA 



1059 MRS 
FI LKO 

UUU REOIUN 



LUm'UlAllUN SUKMARY 



06 



PCN N AA - b t 



01 JUL - 30 SEP F Y 90 



YEAR 10 0A1E 



DIRFC1 


SUPPLR 1 


ANC1L 


AFHR 


KE 1 


PUR1F1EU 


EXPENSE 


CUblS 


C0S1S 


S1PD* 


PLR1F 


EXPENSE 


7336024 


5011125 


755208 7 


19901236 





19901236 


1620449 


1073164 


1507250 


4400863 


4b5854- 


3915009 


1C648 


3/6929 


1115386 


156496- 


9/1223 


2536186 


1C648 


376V29 


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29233 


68 788 


319044 


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915950 


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16627 


12354 


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30961 


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618774 


59829 


2386145 


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373059 


34695 


1302238 


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615256 


245715 


24934 


1085901 


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562387 


481645 


2208068 


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4087425 


159543 


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11540 


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11540 


27025 


52406 


126935 


18134 3 


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10569 


53624 


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20260 


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10569 


53624 


82622 


20280 


103102 


61437 


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309077 


419322 


96355 


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61437 


4 8806 


309077 


41VJ22 


96J55 


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267625 


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115313 


505637 


66882 


53617 


267625 


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115313 


505637 


225054 


37678 


1132 


263861 


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225054 


3 76 76 


1132 


263864 


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1652805 


989844 


1163731 


3807386 


566/54- 


3240632 


71608 


95666 


417203 


590497 


200594 


791091 


71606 


95686 


41 7203 


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200594 


791091 


132982 


357937 


639201 


1130120 


1319421 


2449541 


132982 


35 7937 


639201 


11301*0 


13194*1 


244954 1 


1443215 


536221 


1C7333 


2 086 /69 


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1442215 


53622 1 


107333 


2C86769 


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13S4939 


76/049 


567062 


2 /49050 


534503- 


2214547 


111261 


139083 


335202 


585546 


502320 


108 7866 


111261 


139083 


335202 


5855 46 


5D2320 


1087866 



43 



APPENDIX G (INPATIENT NAS REPORT) 



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60 



APPENDIX H (HEALTH CARE SUMMARY) 



CHAMPUS HEALTH CARE SUMMARY 
BASED ON CARE RECEIVED 
025 - HAYS 



SUMMARY BY 

*JW8B. 



PRIMARY DIAGNOSIS 
1989 THRU SEP 1990 
CA 



COLLECTION PERIOD: 



ALLERGY 



8 
6 



z 
9 

29 

5.22 

0.08 

15,097 

1,870 

16,967 

1,677.44 

520.59 



CARDIOLOGY 

(VASCULAR 

DISEASE ) 

47 

7 

18 

22 

59 

254 

4.31 

0.70 

458,790 

52,961 

7^776 7 fo 
1,806.26 



DERMATOLOGY 



1 
00 
00 



3,j 

4,: 



12 

7 



5 

18,559 

2,806 

21.165 

2,059.89 

655.07 



444 

273 

39 

133 

,370 

1,411 

55,388 

25,280 

78,663 

56.97 




007 (OHRJ6QI 
,TE: 2? JAN 1991 
ME: 16:20:07 

7B.BENE ZIP UNDUPLICAU 

(*******»»*»****»*,»**»***#*#***#*#***»•**** CATEGORY OF CARE. - .INTERNAL MEDICINE *«*»)»«»»»*»»i»»««<>»««»*»*«»i»«*««*»«« »»»«»»«•« • 

ADVERSE 
REACTIONS 
IPAIItNT HOSPITAL SERVICES 

BENEFICIARIES 6 

'NT OF ACT DUTY SPONSOR 2 

IREE 

'NT OF RET OR DEC SPONSOR 4 

HOSPITAL ADMISSIONS 6 

TAL DAYS 26 

iGE LENGTH OF STAY I DAYS ) 4.33 

iGE DAILY PATIENT LOAD 0.07 

. GOVERNMENT COST 10,0e3 

PATIENT COST 2,471 

GOVT ANO PATIENT COST 12,554 

IOVT COST PER ADMISSION 1,680.50 

;OVT COST PER DAY 587.81 

IPATIENT PROFESSIONAL SERVICES 

BENEFICIARIES 14 

NT OF ACT DUTY SPONSOR 10 

IREE 

NT OF RET OR DEC SPONSOR 4 

R OF VISITS 22 

R OF NON-VISIT SERVICES 24 

. GOVERNMENT COST 3,627 

, PATIENT COST 1,426 

, GOVT AND PATIENT COST 5,053 

ITAL INPATIENT SERVICES 

BENEFICIARIES 18 

NT OF ACT DUIY SPONSOR 11 

IREE 

NT OF RET OR DEC SPONSOR 7 

GOVERNMENT COST 13,710 

PATIENT COST 3,693 

GOV1 AMD PATIENT COST 17,608 

IOVT COST PER ADMISSION 2,285.00 

iOVT COST PER DAY 527.31 

ITPAIIENT PROFESSIONAL SERVICES 

BENEFICIARIES 642 

NT OF ACT DUTY SPONSOR 517 

IREE 29 

NT OF RET OR DEC SPONSOR 97 

R OF VISITS 692 

R OF NON-VISIT SERVICES 586 

GOVERNMENT COST 78,4 76 

PATIENT COST 20,550 

GOVT AND PATIENT COST 99.026 

;ovr cost per visit 113.40 

ITPATIENT CARE COST SHARED AS INPATIENT 

BENEFICIARIES 

'NT OF ACT UUIY SPONSOR 

IRtf 

NT Of l!FT OR DFC SPONSOR 

GOVERNMENT COST 

PATH NT COST 

. GOVT ANO PATIENT COST 

HAL INPATIENT AND OUTPATIENT CARE 

BENEFICIARIES 650 

NT OF ACT DUIY SPONSOR 52 3 

IREE 29 

NT OF RET OR DEC SPONSOR 99 

GOVERNMENT COST 92,185 

PATIENT COST 24,448 



1 



445 
2 74 

ill 

71,747 
28,085 



109 

27 

45 

37 

565,614 

123,630 

694,244 

9,586.68 

2,226.83 



1 ,026 

284 

356 

407 

1,968 

2,891 

207,614 

159,685 

547,297 

105.49 



1,061 

295 

54 7 

420 

773,228 



2,924 
125 

3,049 
2,924.00 
2,924.00 



5 




5 
9 

2,102 



5 





5 

4,209 

94 2 

5,151 

4,209.00 

4,209.00 



1:!8§ 

162 

39^ 

1,987 

2,251 

140,780 

54,391 

195.171 

70.85 



GOVT AND PATIENT COST 116,655 99,852 1,041,542 200.521 108,95 

REFER TO PAGE 1 I SPECIFICATIONS PAGE I OF THIS REPORT FOR CLARIFICATION OF THE DATA HHICH APPEARS 



268 
1,041 



,314 



1 ,664 

1,108 

162 

596 

144,988 

55,333 





GASTRO- 




RINOLOGY 


ENTEROLOGY 


HEMATOLOi 


1 


19 




1 


I i 







2 







7 




1 


. 1 




5 


85 




5.00 


4.05 


. : 


0.01 


0.25 





3,063 


57,276 


1 6 9 , < 


42 


11 ,457 


1 1 , 


3,105 
3,063.00 


68,715 
2,727.43 


181.' 

21,211 


612.60 


675.84 


1 ,390 


10 


54 




5 


22 




2 







I 


7 




19 


120 




28 


150 




MP 


z mi 


15, t 
2, 


4,130 


29,752 


10,! 


10 


-■• 




5 


.0 




2 


7 




3 


11 




5,9o0 


78,354 


185,! 


1,275 


20,130 


l'i,« 


7.255 
5,960.00 


98,464 
5,756. 19 


200.1 
23.196 


1,192.00 


921.58 


1 ,520 


407 
118 


1.016 




655 




96 


107 




194 


255 




830 


1,179 


: 


852 


1,559 


c 


56,869 


182,793 


137.: 


44,829 


e5,459 


22, c 


101,718 
68 . 54 


248,257 
155.04 


160 .' 

4l 7 


U 







II 


il 




II 







1) 


'I 












II 


II 




II 


II 




415 


1 .059 




122 


670 




97 


1C3 




195 


265 




62,849 


261,132 


322, t 


46,104 


85,589 


3 7,1 


108,955 
APPEARS ON 


346,721 
THIS REPORT. 


360,1 





6] 



Hi'OMB 007 (OHRJbQt 
RUN DATE: 29 JAN 1991 
RUN TIME: 16:20=07 
MODE: 7B.BENE ZIP 
•a********************************************* CATEGORY OF CARE 



CHAMPUS HEALTH CARE SUMMARY BY PRIMARY DIAGNOSIS 



BASED ON CARE RECEIVED FROM OCT 1989 THRU SEP 1990 
HAYS AH FT ORO , CA 



023 



COLLECTION PERIOD: II 



UNDUI 

INTERNAL MEDICINE »«»»*»•*»»»»*»«•»•»»»»»»**•« «««««» «»»»• 



I 



INPATIENT HOSPITAL SERVICES 



USER DENEF 

DEPNT OF 

RETIREE 

DEPNT OF 

TOTAL HOSP 

HOSPITAL D 

AVERAGE LE 

AVERAGE DA 

TOTAL GOVE 

TOTAL PATI 

TOTAL GOVT 

AVG GOVT C 

AVG GOVT C 



ICIARIES 

ACT DUTY SPONSOR 

RET OR DEC SPONSOR 
ITAL ADMISSIONS 
AYS 

NGTH OF STAY I DAYS I 
ILY PATIENT LOAD 
RNMENT COST 
ENT COST 

AND PATIENT COST 
OST PER AOMISSION 
OST PER DAY 



INFECTIOUS 
DISEASE 



3 

3 





5 

15 

5.00 

0.04 

5,989 

140 

6,129 

J96.33 

599.27 



li 



II INPATIENT PROFESSIONAL SERVICES 

USER BENEFICIARIES 

DEPNT OF ACT DUTY SPONSOR 

RETIREE 

DEPNT OF RET OR DEC SPONSOR 
NUMBER OF VISITS 
NUMBER OF NON-VISIT SERVICES 
T 1)1 Al GOVERNMENT COST 
IOIAL PATIENT COST 
TUIAL GOVT AND PATIENT COST 

III TOTAL INPATIENT SERVICES 

UfER BENEFICIARIES 

DEPNT OF ACT DUIY SPONSOR 

RETIREE 

DEPNT OF RET OR DEC SPONSOR 
1UIAL GOVERNMENT COST 
TUIAL PATIENT COST 
10TAL GOVT AND PAIIENT COST 
AVG GOVT COST PER ADMISSION 
AVG GOVT COST PER DAY 

IV OUTPATIENT PROFESSIONAL SERVICES 

Uf.ER BENEFICIARIES 

DEPNT OF ACT DUIY SPONSOR 

RETIREE 

IIEPNI OK RET OR DEC SPONSOR 
NUMBER OF VISITS 
NUMBER OF NON-VISIT SERVICES 
TOTAL GOVERNMENT COST 
TOTAL PATIENT COST 
TOTAL GOVT AND PATIENT COST 
AVG GOVT COST PER VISIT 



8 

o 
1 
1 
56 
3 
,119 
,516 



7,635 



10 

a 

1 
1 

12,103 

1,656 

13,764 

4, 036. 00 

807. 20 



R64 
716 

35 

113 
1,014 

736 

76,533 

26,223 

102,756 

75.48 



NEPHROLOGY 



984. 14 



75 
50 

12,899 
4,078 

16,977 



i3 



76,868 

17,216 

94.084 

9,606.50 

1,182.58 




59 
37 

i| 

102,888 



NEUROLOGY 

15 

4 

3 

15 

116 

7.73 

0.32 

73,587 

4,144 

77i731 

4,905.80 

634.37 



30 
14 

7 
9 

J 17 

178 

46,588 

21,300 

67,888 



37 

20 

7 

10 

120,175 

1,035.99 



660 

380 

88 

195 

1,343 

1,403 

149,237 

52,815 

2 ?fi°fi 



V OUTPATIENT CARE COST SHARED AS INPATIENT 

U:>ER BENEFICIARIES 

DEPNT OF ACT DUTY SPONSOR 

RETIREE 

DEPNT OF RET OR DEC SPONSOR 

10TAL GOVERNMENT COST 

TOTAL PATIENT COST 

IOIAL GOVT AND PATIENT COST 

VI IOIAL INPATIENT AND OUTPATIENT CARE 

USER BENEFICIARIES 872 

DEPNT OF ACT DUTY SPONSOR 723 

RETIREE 35 

DEPNT OF RET OR DEC SPONSOR 114 

TOTAL GOVERNMENT COST 83,640 

IOIAL PATIENT COST 27,879 28,367 78,25? 

TOTAL GOVT ANO PATIENT COST 116,519 131,255 547,671 

NOTE: REFER TO PAGE I (SPECIFICATIONS PAGE) OF THIS REPORT FOR CLARIFICATIO 



671 

387 

90 

197 

269,412 



NUTRITIONAL 















0.00 

0.00 







0.00 

0.00 



1,60! 

1,976 



31 

22 

3 

6 

3,486 

4,4 9 fl 



PULMONARY/ 
RESPIRATORY 



43 

13 

12 

18 

43 

215 

5.00 

0.59 

215,378 

49,308 



264,68 
5,00$. 7 
1,001.7 



81 
24 
29 
28 
387 
408 



48,235 
21,621 
69,856 




s ti: 



1 ,659 

1.118 

252 

491 

2,410 

15,649 

221,545 

87,446 

309,991 

, 93 



1,897 

1,136 

262 

501 

485,158 

158,375 

643,533 



RHEUMATOLOGY 1 



4 

1 

3 
5 
45 
.00 
12 



9. 

0._ 

23,005 

8,535 

31,540 

4,601.00 

511.22 



11 



4 

7 

4 

106 

10,593 

15,308 

25,901 




6,719.80 
746.64 



298 

61 

94 

144 

9h9 

870 

58,925 

32,864 

91.789 

62.09 



30f 

62 

96 

147 

92,524 

56,708 

149,232 



1 •»,»t>, OH3,D33 It7ji3i 

ON OF THE DATA HHICH APPEARS ON THIS REPORT 



62 



007 lUHRJbQ) CHAMI'US HEALTH CARE SUMMARY BY PRIMARY DIAGNOSIS 

TE: 29 JAN 1991 BASED ON CARE RECEIVED FROM OCT 1989 THRU SEP 1990 COLLEC1ION PERIOD: 15 I 

ME: 16:20=07 025 - HAYS AH FT ORD , CA 

7B.BENE ZIP UNUUPl I \ 

a************************************************* CATEGORY OF CARE »#*********»**»****«»****<•»»»«««#*«******»**»»*>»»»»»«•"'-• 



PATIENT HOSPITAL SERVICES 

BENEFICIARIES 

NT OF ACT DUTY SPONSOR 

IREE 

NT OF RET OR DEC SPONSOR 

HOSPITAL ADMISSIONS 
TAL DAYS 

GE LENGTH OF STAY I DAYS ) 
BE DAILY PATIENT LOAD 

GOVERNMENT COST 

PATIENT COST 

GOVT AND PATIENT COST 
OVT COST PER ADMISSION 
OVI COST PER OAY 



DENTAL 







I) 

1) 





0.00 

0.00 



CJ 



0.00 

0. CD 



PAI1LNI PROFESSIONAL SERVICES 

BENEFICIARIES 

NT OF AL1 DUIY SPONSOR 

IREE 

Nl OF RET OR DEC SPONSOR 

R OF VIS11S 

R OF NUN-VISIT SERVICES 

GOVERNMENT COST 

PATIENT COST 

GOV? AND PATIENT COST 

IAL 1NPAIIENI SERVICES 

BENEFICIARIES 

IIT OF ACT DUTY SPONSOR 

IRFE 

IIT OF RET OR CJ[ C SPONSOR 

GOVERNMENT COS I 

PATIENT COST 

GOVT AND PAIIENI COST 
DVT COST PER ADMISSION 
DVT COST PER DAY 

1PATIENT PROFESSIONAL SERVICES 

UfcNFFICl ARITS 

Nl OF AC I L-UIY SI'UNSUI! 

IREE 

Nl OF RET OR DEC SPONSOR 

R OF VISITS 

R OF NON-VISIT SERVICES 

GOVERNMENT COST 

PATIENT COST 

GOVT AND PATIENT COST 
OVT COST PER VISIT 

TPATIENT CARE COS1 SHARED AS INPATIENT 

BENEFICIARIES 

NT OF ACT DULY SPONSOR 

IREL 

NT OF P.ET CR DEC SPONSOR 

GOVERNMENT COST 

PATIENT COST 

GOV J AND PATIENT COST 



1 
1 



1 
1 

1 ,315 



1,315 



1 
1 
n 
o 

,315 


0.00 
0.00 



1 ?n 

111 

4 

13 

14 1 
54 
555 
309 
36-t 



89.0 



OBSTETRICS 



,06 



loo 



6 

112 

307 

2. 74 

0.64 

208,435 

8,997 

217,432 

1,861.03 

b78. 9^ 



240 

224 



17 

119 

1.456 

lb0,171 

56,655 

216,826 



259 

242 



18 

368,605 

o5,652 

434,257 

3,291.12 

1,200.67 



214 

20/ 



8 

126 

417 

lCl.OOO 

19,626 

140.626 

966.32 



Z 
2 



35 


'.5 



3 78 

359 



21 

469,640 

85,278 

574,918 



GYNECOLOGY OPHTHALMOLOGY 



25 

21 



<* 

25 

100 

4.00 

0.27 

71,831 

6,280 

78,111 

2,873.24 

718.31 



h8 

J5 



13 

21 

282 

31,b27 

29,002 

60,629 



52 

IS 



14 

103,459 

35,282 

138.741 

4,138.36 

1,034 59 



,162 

8U2 

3 

358 

,57b 



TAL INPATIENT AND OUTPATIENT CARE 

BENEFICIARIES J 2S 

NT OF ACT DUTY SPONSOR 111 

IRLI 4 

IT OF RET OR DEC SPONSOR 13 

GOVERNMENT COST 13,370 

PATIENT COST 4,309 

GOVT ANO PATIENT COST 18,179 
<EFER TO PAGE 1 I SPECIFICATIONS PAGE I OF THIS REPORT FOR C 



3,027 
252,346 

91 ,016 
343,362 

166.12 



1 ,163 

818 

3 

3o3 

155,804 




2 
3 
5 
67 
(Jl 



8,420 
375 

8.795 
2,806.67 
1 ,684.00 



I 1 
b 



10 
00 



126,298 

:larificatio 



10,997 
12,104 
23,101 



12 

b 

2 

4 

19,417 

12,479 

31,896 

6,472.33 

3,883.40 



92b 

521 

151 

255 

1,393 

443 

148,158 

79,853 

228,011 

106.36 



930 
524 
151 
256 

167,575 
92,332 

259,907 



PSYCHIATRY 
GROUP 1 



47 
26 

8 
14 

52 

l.O'ib 

21 .08 

3.00 

962,641 

45,226 

508,067 

8,900. 79 

422 30 



37 


9 

3 73 

33,224 



59 
32 

10 

18 

,051 

,239 

,290 



491 

50 

541 



9,443.29 
4*48 n<» 



'(i0 

57 

185 

4 .567 

368 

297,513 

96,049 

393, 5b2 

65. 14 



710 

■<5 7 

64 

1 Q 4 

788,564 

146,289 

934,853 



PSYCHIATRY 
GROUP 2 



I, 

.8 

2 

4 

3h 

805 

23.68 

2.21 

216,406 

22,125 

238,531 

6,364.83 

268.83 



1" 

5 
5 



i; 

6 

8,149 

1,120 

9,2o9 



4 7 
33 

a 

22^,555 

23,295 

247,600 

6,604.5o 

278. u 5 



<t*)0 

S5o 

44 

99 

3,b04 

23o 

226 ,04h 

68,235 

294,279 

bi.72 



3 75 

m8 

IOo 

450,599 

91,481 

542,080 



\JC £3">,^U/ T3H,03i ItliUOU 

ION OF THE DATA HIIICH APPEARS ON THIS REPORT 



63 



HR085007 (OHRJbQ) CHAMPUS 

RUN DATE: 29 JAN 1991 BASED ON 

RUN TINE: 16=20:07 
MODE: 7B.BENE ZIP 

it********************************************** 



INPATIENT HOSPITAL SERVICES 



EAR, NOSE 
AND THROAT 



HEALTH CARE SUMMARY BY PRIMARY DIAGNOSIS I' 

CARE RECEIVED FROM OCT 1989 THRU SEP 1990 COLLECTION PERIOD: 15 

023 - HAYS AH FT ORO , CA 

UNOUP 
;**# CATEGORY OF CARE - SURGERY «»»»»»»«««»»»«»«««»»»*«»»<««»»««»»»»»»»»»»i'*»ii 

GRAND 
GENERAL NEURO- THORACIC FOR A 

SURGERY SURGERY ORTHOPEDICS SURGERY UROLOGY CATEGO 



USER BENEFICIA 
UEPNT OF ACT 
RETIREE 
DEpNT OF RET 
TOTAL HOSPITAL 
HOSPITAL DAYS 
AVERAGE LENGTH 
AVERAGE DAILY 
10IAL GOVERNME 
TOTAL PATIENT 
TOTAL GOVT AND 
AVG GOVT COST 
AVG GOVT COST 



RIES 
DUTY SPONSOR 

OR DEC SPONSOR 
ADMISSIONS 

OF STAY (DAYS I 
PATIENT LOAD 
NT COST 
COST 

PATIENT COST 
PER ADMISSION 
PER DAY 





1 

5 

7 

40 

02 



II INPATIENT PROFESSIONAL SERVICES 

USER BENEFICIARIES 

DEPNT OF ACT DUTY SPONSOR 

RETIREE 

DEPNT OF RET OR DEC SPONSOR 
NUMBER OF VISITS 
NUMBER OF NON-VISIT SERVICES 
TOTAL GOVERNMENT COST 
IO[AL PATIENT COST 
10IAL GOVT AND PATIENT COST 

III TOTAL INPATIENT SERVICES 

USER BENEFICIARIES 

DEPNT OF ACT DUTY SPONSOR 

RET 1PLE 

DEPNT OF RET OR DEC SPONSOR 
10IAL GOVERNMENT COST 
IUIAL PATIENT COST 
TOTAL GOVT AND PAIIENT COST 
AVG GOVT COST PER ADMISSION 
AVG GOVT COST PER DAY 

IV OUTPATIENT PROFESSIONAL SERVICES 

HI R I'.ENII 1CIARIES 

HLITIT 01 ACI DUIY SPONSOR 

KETIRLE 

IJHPNI 01- RL( OR DEC SPONSOR 
NUMBER 01 VIST IS 
NUi;3Eli OK NON-VISIT SERVICES 
101 AL GOVERNMENT COST 
TOTAL PATIENT COST 
TOTAL GO/T AND PATIENT COST 
AVG GOVT COST PER VISIT 



9,519 
545 

9,864 
1 ,863.60 
1,331.29 



11 

7 

1 

3 

20 

41 

9,807 

2,250 

12,057 



12 

6 
1 

9,1Tb 
2,795 

1,^21 

2S.7.0 
9 



2 
3,3 
2,7 



34 

7 

41 



3.04 3 
2,531 

144 
^72 

5.5 12 
1,7.0 
4,2:9 
3,. ".56 
7,705 
61.67 



V OUIPAIIENI CARE COST SHARED AS INPATIENT 

U' ER BENEFTCIARIES 

DEPNT OF ALT DUIY SPONSOR 

RETIREE 

DEPMT OF RE I OR DEC SPONSOR 

TOTAL GOVERNMENT COST 

IOTAL PATIENT COST 

IOIAL GO'.'T AND PATIENT COST 

VI TOIAL INPATIENT AND OUTPATIENT CARE 



ir.ER BENEf ICIARIES 

DEPNT OF ACI DUIY SPONSOR 

RETIREE 

DEPNT OF RET OR DEC SPONSOR 
101AL GOVERNMENT COST 
TOIAL PATIENT COST 



78,023 

548,322 

9,405.98 

1,754.85 



1 ,9o3 
1,274 

iea 

502 

2,273 

2,531 

355,487 

139,95* 

495,441 

156.40 




98,963 



33 

10 

13 

10 

230,960 

67,346 

298,306 

10,498.18 

1,408.29 



160 

58 

38 

64 

896 

4,763 

210,020 

49,387 

259,407 

234.40 



3,050 2,016 

2,534 1,30a 

lt5 198 

375 514 

363,355 825,786 

76,351 217,978 

TOTAL GOVT AND PATIENT COST 439,706 1,043,764 
iOIF. : REFER 10 PAGE 1 I SPECIFICATIONS PAGE) GF THIS REPORT FOR CLARI 



io 9 



20 

138 

6.90 

0.38 

83,038 

19,587 

102,625 

4,151.90 

601.72 




n 

20 

160,011 

65,187 

225.198 

», 000.55 

L, 159. 50 






i 

4 

7 

35,261 

4,901 

40,162 

7,052.20 

1.305. 96 




HHICH AP 




40 
20 

i° 

10 

38,537 

22,143 

60,680 

5,505.29 

1,243.13 



355,526 
98,203 

453,729 
234.52 



1,241 
873 
113 
256 
394,063 



10, 



THIS 



514,409 
Re PORT. 



34« 
40' 



64 



APPENDIX I 



SUMMARY OF COSTS /WORKLOAD 



Total OBD's Cost Per Total Cost Per ALOS 
Exp OBD's Admiss. Admiss. 



MEPRS 2449541 4844 505.69 1628 1504.63 3.0 
CHAMPUS 314365 272 1155.75 98 3207.80 2.77 



65 



APPENDIX J 



INPATIENT SPECIALTY 

FORT ORD ARMY HOSPITAL, FY 1990 

UCA CODE DESCRIPTION 



AAAA INTERNAL MEDICINE 

AABA CARDIOLOGY 

AAFA GASTROENTEROLOGY 

AAHA INTENSIVE CARE MICU 

AAJA NEUROLOGY 

ABAA GENERAL SURGERY 

ABCA INTENSIVE CARE SICU 

ABEA OPTHALMOLOGY 

ABFA ORAL SURGERY 

ABGA OTORHINOLARYNGOLOGY 

ABKA UROLOGY 

ACAA GYNECOLOGY 

ACBA OBSTETRICS 

ADAA PEDIATRICS 

ADBA NURSERY 

AEAA ORTHOPEDICS 

AEBA PODIATRY 

AFAA PSYCHIATRY 



66 



APPENDIX K (GLOSSARY) 

1. MTF - Military Treatment Facility 

(same as Military Hospital) 

2 . DoD - Department of Defense 

3. ALOS - Average Length of Stay 

4. FY - Fiscal Year 

5. OBD - Occupied Bed Day 

6. NAS - Non Availability Statement 

7. CHAMPUS - Civilian Health and Medical Program of the 

Uniformed Services 

8. DEERS - Defense Eligibility and Enrollment Reporting 

System 

9. MEPRS - Medical Expense and Performance Reporting System 



67 



LIST OF REFERENCES 



1. Office of Civilian Health and Medical Program for the 
Uniformed Services (OCHAMPUS) , CHAMPUS Handbook , Aurora, 
Colorado, July 1990. 

2. Office of Civilian Health and Medical Program for the 
Uniformed Services (OCHAMPUS) , CHAMPUS Chartbook of 
Statistics , Aurora, Colorado, August 1990. 

3. Rand Corporation Report N-2647-HA, Plan for an Evaluation 
of the CHAMPUS Reform Initiative , by Hosek, S.D., and 
others, July 1987. 

4. Willis, G., "Scarcer Resources May Create Pay, Benifits, 
PCS Problems," Navy Times , 05 April 1991. 

5. Nelson, S.S., "New Managed Medical Plan - Sign Up or B e 
Penalized," Navy Times , 29 April 1991. 

6. Office of the Director Palo Alto Veterans Medical Center 
UNCLASSIFIED Letter 640/11C to Monterey County Veterans 
Services, Sub j : Veterans Eligibility - Veterans Health 
Care Amendment 99-272, June 6, 1990. 

7. Delta Dental Plan of California (DDP*DELTA) , Summary Plan 
Description Booklet , Sacramento, California, August 1990. 

8. Center for Naval Analyses Report CRM 8 9-257, Comparing MTF 

and CHAMPUS Costs Using Patient Treatment Protocols , by 
May, L.J., and others, February 1990. 

9. Rand Corporation Report N-3069-HA, Preliminary Results 
from an Evaluation of the CHAMPUS Reform Initiative , by 
Hosek, S.D., and others, January 1990. 

10. Center for Naval Analyses Report CRM 90-7, Estimating the 
Cost Effectiveness of Recapturing CHAMPUS Workload , by 
Laurie J. May, May 1990. 



68 



INITIAL DISTRIBUTION LIST 



Defense Technical Information Center 

Cameron Station 

Alexandria, Virginia 22304-6145 

Library, Code 52 

Naval Postgraduate School 

Monterey, California 93943-5002 

Dr. Dan Trietsch 

Code AS/TR 

Naval Postgraduate School 

Monterey, California 93943-5002 

LCDR Ken Steiner, USN 

Code AS/ST 

Naval Postgraduate School 

Monterey, California 93943-5002 

Commanding Officer 
Health Sciences Education and 
Training Command, Code MSC-2 
National Naval Medical Center 
Bethesda, Maryland 20814-5022 

USA MEDDAC 

Attn: Mr. Terry Williams 

HSXT-RMD 

Silas B. Hays Army Hospital 

Fort Ord, California 93941 

LT Julito P. Laluan, MSC, USNR 
4927 Springwood Circle 
Fairfield, California 94585 



69 






. 






Thesis 
L24645 
c.l 



Laluan 

Military health' care 
system.